Schadenfreude Comes Close: How Republicans can kill the AHCA, win health care, and help save democracy.

Schadenfreude isn’t exactly the right word to describe how I feel watching Republicans flail around on health care reform, but it moves in the right direction. It must be tremendously frustrating to be a Republican Senator, Representative or staffer right now. Your party controls the House, Senate, and the White House. You ran on fixing health care, something everyone seemed to agree was broken. But the solution is just beyond your grasp. Pulling on one policy thread unravels parts of the sweater you didn’t even know existed. And while everyone hates Obamacare they seem to like the Affordable Care Act more and more. To quote the President, it’s as if “nobody knew health care could be so complicated.” As an added bonus, House Speaker Paul Ryan went all-in on Trump — even after a thinly veiled attack on Trump’s bombast during the primaries — and Trump already blamed him for the failure of health care reform before the vote has even been held.

I am one of the (many, many) people who knew that health care could be complicated. I was brought in as a senior policy advisor by U.S. Rep. Steve Kagen, MD (D-WI) to help get his ideas about health care reform included in what became the Affordable Care Act. I worked in the district office of U.S. former Rep. Sam Coppersmith (D-AZ), a supporter of Clinton’s health care reform package, and part of my job was to promote the legislation to small business owners in the Phoenix area. I am also married to an attorney with a health policy background, and until Jan. 18 of this year was an Obama-appointed Senior Advisor to the Commissioner of the U.S. Food and Drug Administration.

My joy at the pain Republicans are feeling is compounded by the fact that Republicans are trying to undo what is basically a Republican law. The 1993 Health Equity Access Reform Today Act (HEART Act) included a mandate to purchase insurance, standardized plans, a prohibition on denying coverage because of pre-existing conditions, among other things. The bill’s 20 cosponsors included current Sen.s Orrin Hatch (R-UT) and Charles Grassley (R-IA). 2012 Republican presidential nominee Mitt Romney concedes that the health care plan he signed into law as the governor of Massachusetts is the basis of the ACA.

The ACA makes sure people take responsibility for themselves by buying health insurance, thereby making sure everyone pays their own bills. Making people buy insurance means more money for insurance companies; the law forces individual responsibility and is good for big business at the same time, a Republican win-win. The law sets up exchanges where companies can compete for customers, a free market solution. And the ACA allows states to experiment in all sorts of ways to manage their own specific health insurance needs, another fundamentally Republican principal.

For a while the Republican approach to health care reform looked pretty genius: get the Democrats to pass a Republican bill, then blame the Democrats when people don’t like it. But the unexpected happened — the Republicans won power. The dog finally caught the bus it had been chasing. Turns out a bus is more fun to chase than to chew.

So, yah, part of me wants to enjoy the misery of Republicans trying to figure out how to pass a bill that takes health care from 24 million people without getting creamed at the polls.

But only part of me feels this way. The Republican approach and Republican bill will be a fiscal disaster and seriously hurt or kill millions of people. The politics of the policy nearly guarantees there will be more changes in the coming years as elected officials feel the heat from those who are suddenly without insurance or care, meaning more pain and more uncertainty. And it has the added disadvantage of continuing to divide Americans into trenches, throwing marchers and threats at each other. The current debate is the worst of all possible political and policy worlds.

The good news is that there are solutions that are both good policy and good politics.

Step one is throwing Trump under the bus. Someone has to take the blame for this fiasco; strategically, it makes sense for that person to be a guy who is a sinking political stone. He will rant and rave, but he will do that anyway — and the more he does that the lower his numbers go, and the more he rants and raves, and so on.

Step two is identifying the reason for the new approach (more on that in a minute). I suggest the Vice President. The way things are going he might be the President soon anyway, and he is probably the Republican’s best hope to keep the White House in 2020. Promote him rhetorically now and isolate Trump as an unpredictable leader and unreliable ally.

Step three is governing.

Announce that at the request of Vice President Pence, a former member of Congress and a Governor who successfully expanded Medicaid, you are breaking the AHCA into smaller, focused, pieces. In addition, at the request of the Vice President, you are working with Republicans and Democrats to find solutions on which you can agree before moving on more controversial measures. Both sides have claimed to want to do that in the past, but that was just posturing. Democrats started it, and some Republicans continued it. The Trumpcare fiasco proves that bullying and bluster no longer work, nor should they. The American people demand, and deserve, better. America is better than the past several years. So Republicans are doing the right thing and focusing on problem solving, not finger pointing. This is your moment to echo Republican Governor and one-time Presidential candidate John Kasich (R-OH) and end the partisan warfare on healthcare.

The pieces to move, and the order in which to move them:

Identify key elements of the ACA with broad support and that you like and articulate those — for example, barring insurance companies from denying coverage because of pre-existing conditions, letting kids stay on their parents’ plans until they are 26, mental health and addiction treatment coverage, and so forth. These are things on which all Americans can agree.

Identify elements of the ACA that could be done away with that would make minor policy changes but could score political points — sort of a clearing of the underbrush. For example, I’m not sure anyone would miss the mandate for calorie information on vending machines. This would be an example of Republicans standing up against extraneous regulations and silliness in government.

Identify elements of health care reform on which you can get bi-partisan support (maybe not Freedom Caucus or Bernie Caucus, but the vast swath in between) — things like greater transparency in pricing (there are challenges with this policy, but could be worth pursuing).

Then you can then take on the more partisan elements of the bill including a mandate versus tax incentives and block-granting Medicaid.

Accomplishing these goals will not be easy. Governing is hard. But they make for good policy that will markedly improve the lives of your constituents and your colleagues’ constituents. The approach has the added advantage of starting to fix a broken system. You will be working together to move legislation, which is what our democracy demands. This is good policy and good political philosophy.

It is also good politics. You will be moving legislation that people support, getting rid of seemingly pointless elements of a bill people don’t like one of the names of but like the substance of, and claiming moral victory in the partisan sideshow that has become American politics. Win, win, win.

Again, I am not offering you this advice because I am a Republican looking score points against Democrats and a failed bill. Quite the opposite. I simply believe deeply in our democratic system and I am afraid our system is at risk of slipping into a political Battle of Verdun. It’s time for that nonsense to end, and this is a good place to start.